A Look Back: A Year Spent Advocating for Women’s Health

Throughout my long career as an ob-gyn, I’ve never been witness to a more intense national focus on the health care provided to American women than I have in this past year as president of ACOG. We’ve seen the deaths of pregnant women during and after childbirth take center stage as our understanding of the embarrassing U.S. maternal mortality rate grew. Countless labor and delivery unit closures at rural hospitals across the country have drawn attention to access to care, and many were shocked to learn that nearly half of U.S. counties lack a practicing ob-gyn. Legislative attacks on women’s health care have spread like wildfire, as both federal and state governments have attempted to restrict women’s ability to obtain health coverage and contraception, obstruct their access to abortion care, and institute punitive measures for pregnant women suffering from drug addiction. From the beginning, it was clear that the challenges facing our specialty—and to us, the physicians who care for women throughout their lifespan—are immense.

Before I officially took the reins in May 2017, we were already in the midst of the work, advocating against efforts in Congress to strip health care from millions of women through the repeal of the Affordable Care Act (ACA). Women stood to lose access to no-copay contraception, affordable maternity care, and essential preventive services. Women were at risk of returning to a time where they might have been denied coverage based on a prior C-section or had to pay more for insurance based on their gender, and Medicaid coverage for hundreds of thousands of low-income women would have been in jeopardy.

All of this played out in the news as ACOG fought fiercely alongside five other provider organizations in a coalition called the Group of 6. We batted down every iteration of legislation that would have been detrimental to the health of the women in this country. We lobbied, we rallied, we spoke to the media, and we galvanized ACOG members in support of this common cause. I am proud of what we accomplished, and I count the tremendous effort to defeat ACA repeal as one of the successes of my presidency. But, of course, there was much more work to be done.

In addition to my time at ACOG, a large focus in my career has been on perinatal health disparities and maternal mortality. More than 60 percent of maternal deaths are preventable, and more than 65 percent occur within the first week postpartum. One way ACOG is trying to address this is through the Preventing the Maternal Deaths Act. It would provide grant funding to states to establish or bolster maternal mortality reviews committees tasked with studying the causes of these deaths, and how they can be prevented. But these statistics also indicate that as providers, we need to change the paradigm when it comes to postpartum care.

As part of my presidential task force, “Redefining the Postpartum Visit,” we began with the premise that postpartum care is the gateway to lifelong health. It is not sufficient for women to have one visit six weeks after childbirth. It is critical for women to be seen within the first three weeks and then on an ongoing basis as needed—up to 12 weeks—to address several issues, including breastfeeding complications, postpartum depression, and chronic conditions such as diabetes and heart disease that often persist long after pregnancy. Women have multiple intersecting health needs, so we must facilitate care coordination between multiple providers to ensure women are able to seamlessly access the support and care they need. The task force just released a Committee Opinion this week and, in the coming months, a companion online toolkit for providers will be developed to assist in providing more holistic care. The latest article from ProPublica outlines how this reinvention of postpartum care will require “sweeping” changes in medical practice and throughout the maternal care system if we are to truly optimize the health of moms.

Another focus of my presidency has been on innovation in technology to improve women’s health, particularly telehealth and telemedicine. According to a Health Affairs study, nine percent of rural counties experienced the loss of all hospital obstetric services between 2004 and 2014. Through my “Telehealth Task Force,” we have been working to develop best practices in ob-gyn to improve access and address fragmentation in care. This has significant implications for the Levels of Maternal Care initiative, which focuses specifically on care access in rural settings. It relies on communication and care coordination between hospitals and birthing centers so that women can be transferred to and receive care from a facility that offers the level of care that best suits their needs. Telemedicine will be key in fostering that communication.

The task force remains committed to addressing issues regarding safety, payment, experimental e-obstetrics, virtual education, video conferencing, virtual monitoring, apps, and the crossover between inpatient and outpatient care. In the future, a telehealth Committee Opinion will be developed, and an ongoing work group will be established to continue this important effort. We are also combating the access issue from a legislative perspective through the Improving Access to Maternity Care Act. It has been passed in the House and currently resides in the Senate. Through this legislation, an official maternal health designation through the Health Resources and Services Administration will be created to better determine shortage areas. This in turn will allow more providers to serve in these areas through loan forgiveness programs and scholarships offered by the National Health Service Corps.

However, in our efforts to improve care on a systematic basis, we must not forget how critical it is to address implicit biases that permeate every aspect of care delivery and contribute to the racial health disparities that have led to our high maternal mortality rate. An often-repeated statistic, is that black women in the United States are three or four times more likely to die during childbirth than white women. It is shocking to most, but it shouldn’t be. Racial health disparities have a long history, and events as recent as what happened in Charlottesville last year remind us we still have a long way to go.

Even when black women have access to health care and advanced education, they are still at a disadvantage when it comes to receiving the quality of care on par with their white counterparts, and the constant stressors of racism and racial biases often put them at higher risk for chronic health conditions. Cardiovascular disease disproportionately affects black women, and stress has been linked as a possible contributor. I have been working with Dr. Lisa Hollier, ACOG’s incoming president, to partner on initiatives with the American Heart Association to address issues with women and cardiovascular disease, and I am confident that she will make marked improvements in this area.

It has been a whirlwind. I have traveled the country and the world in pursuit of advancing women’s health and ensuring that the clock is not turned back. I have worked alongside ACOG leadership and Fellows, including my esteemed colleagues, Drs. Hollier and Gellhaus, to improve maternal health for all women in the United States and serve as a model for women’s health care throughout the world. It has been a rewarding journey, and we have made incredible progress, but I am ready to pass the torch, and wish Dr. Hollier success as she carries it forward—there is much more work to be done, and I look forward to working with her this year as immediate past president.

A Rewarding Journey as ACOG’s President

When I started my term as ACOG’s 67th president last May, I wanted to make a difference in the lives of our members and patients, ensure ACOG’s continued growth, and lift our voice as the leading specialty organization in the nation. In many ways, what we have accomplished in 12 short months has far surpassed my expectations given the complexity of the issues we’ve had to deal with and the extraordinary circumstances we’ve had to navigate and overcome. So, in my last month, I’d like to revisit some of the things that have made this such an impactful year and taken me around the globe.

When I initially laid out my priorities for advocacy and global women’s health, there was no way to know the challenges we would face to protect women’s continued access to reproductive and maternal health care, both domestically and abroad. As my tenure progressed and new challenges presented themselves, increased member engagement became even more essential. So, we leveraged my All-in for Advocacy campaign, an effort to amplify and expand our voice with state and federal policy makers through our member stakeholders. In 2016 and 2017, I traveled throughout the country doing presentations at Grand Rounds and participating in state lobby days and was wowed by the energy and eagerness of our advocates to make positive changes in their home states.  Physicians led efforts to support our patients and our practices, successfully advancing legislation from maternal mortality to Zika and defeating legislation affecting the sacred patient-physician relationship and restricting reproductive health rights.

Also, because of ACOG’s excellent government relations team, we launched the State Legislative Action Center, where ob-gyns are able to learn more about their legislature and elected officials, search active legislation, and find opportunities to take action. And this certainly was the year for action! Ob-gyns had an important voice in the discussions on health care reform and urged policy makers not to turn back the clock on women’s health by repealing the Affordable Care Act. We fought for our patients to have continued access to affordable insurance coverage, comprehensive maternity care, no-cost preventive services such as contraceptives, and consumer protections that would prohibit insurers from denying coverage based on pre-existing conditions or setting annual or lifetime benefit caps. And while the fight is not over, the defeat of the American Health Care Act this past March is evidence that we made a tremendous impact.

We have also made great strides in ACOG’s efforts overseas. Through my own personal work to advance health care in struggling countries, I learned that we as ob-gyns can make a difference in global women’s health by sharing our knowledge and resources. However, extended time away from one’s practice is always very difficult and, for some, next to impossible. One of my goals was to make short-term projects easily accessible and identifiable for ACOG members and I am proud to say that we developed a database of non-profit organizations involved in two-week mission work that allows ob-gyns to get more information and sign up.

We’ve also grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States. Through the hard work of ACOG’s Office of Global Women’s Health, the AIM safety bundle for postpartum hemorrhage has been instituted into practice in a low resource setting in Malawi at a community health clinic and referral hospital.  And it has meant so much to me to see the progress made and the lives saved because of this initiative. Additionally, ACOG helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology through several programs, including Health Volunteers Overseas. I’m particularly proud of this work because I firmly believe that the same high standards we have for health care in the United States are the same standards that should apply to other developing countries around the world.

Lastly, another one of my goals this past year was to continue efforts to address the workforce and practice pattern changes we’ve seen in our specialty by improving ob-gyn resident education models. In 2016, the Council on Resident Education in Obstetrics and Gynecology Education Committee embarked on a complete overhaul of the learning objectives for residents. This effort resulted in the release of the Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 11th edition. We are now surveying mid-career practicing ob-gyns to determine which of the core objectives they actually apply in their practices. Although this was an issue without an easy solution, we must continue to work together and discover ways to improve. And I truly appreciate all the hard work of ACOG’s education staff in helping to facilitate this endeavor.

As I pen my last blog, I feel that my time from president-elect nominee to president has been an incredibly rewarding journey that has literally spanned 400,000 miles, according to my frequent flier program. From trips to the nation’s capital to residencies across the country to small community health centers in Africa, each experience taught me so much and it was a great honor to be able to serve ACOG’s members in the process. If I had to impart any advice to ACOG’s incoming president, Dr. Haywood Brown, it would be to enjoy it because it will fly by. (No pun intended.) Enjoy the year, enjoy the people, and listen to their stories. Everyone has a story!

We Cannot Afford to Have the Clock Turned Back on Women’s Health

As we begin a new year, a lot is at stake for Americans’ health. Our nation’s leaders have promised substantial changes to the Affordable Care Act, from partial to full repeal, without the certainty of a replacement plan. While it can be easy to get caught up in the politics of health care, as ob-gyns our focus has always been on our patients and ensuring that they have access to safe, high-quality health care. That is why a critical part of our work here at ACOG is to advocate for the health of women, and as millions of people face the possibility of losing health insurance coverage in the coming months or years, ACOG’s work has never been more important.

Earlier this month, ACOG partnered with three leading medical organizations—the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians—to urge Congress to avoid repealing the ACA without an immediate replacement which would protect and retain the landmark women’s health provisions in the law.

The ACA is not perfect. In fact, ACOG didn’t endorse it originally because we felt it didn’t meet the needs of our physician members. However, while there’s lots to improve, the ACA does include really important protections for our patients’ health. Insurers must now cover maternity and preventive care and contraceptives. It stops insurers from charging women more than men for the same coverage, prevents insurers from denying coverage to women who were victims of domestic violence or who had a Cesarean delivery in the past. The ACA also guarantees women direct access to their ob-gyns without any limitations.

The coverage provided under the ACA allowed many women to schedule routine doctor’s appointments for the first time in their lives. We all know that when people have insurance, they’re more likely to use preventive care like mammogram and diabetes screenings that prevent more costly and life threatening health problems down the line.

Whatever one’s reservations may be about the law, as physicians we know how devastating it would be for a cancer patient to suddenly lose her coverage or for a pregnant woman to go without prenatal care and deliver a baby preterm because she could no longer afford health coverage. The fact is, low-income women are more likely to suffer from often preventable pregnancy complications and, unfortunately, that is the very population that stands to lose the most unless Congress protects these important benefits, including Medicaid expansion.

Today, 31 states and D.C. have expanded their Medicaid programs, offering coverage to 11 million newly eligible individuals. The most important part of the expansion to women is that those Medicaid programs cover low-income women even if they’re not pregnant. Regular Medicaid programs routinely only cover pregnant women through delivery and a few weeks after.

But speaking more broadly, all women stand to lose essential preventive care if the ACA is repealed. Access to breast cancer screenings decreases women’s likelihood of dying from the disease by up to 50 percent. Routine cervical screenings decrease the odds of late-stage cancer diagnosis by 60 percent. Finally, when women have access to more choices of affordable and effective contraception, including IUDs and implants, rates of unintended pregnancy, unplanned birth, and abortion drop dramatically.

In 2016 alone, 6.8 million girls and women gained health insurance coverage. If the law is repealed, those gains will likely be lost. We cannot turn back the clock on women’s health. The care we provide doesn’t stop in our exam or delivery rooms. It’s our responsibility to advocate on our patients’ behalf and protect their access to affordable, comprehensive health care. So let’s mobilize and use our collective community’s influence and expertise to ensure access to health care in this country.

To become involved in ACOG’s advocacy efforts, join us at the 35th Congressional Leadership Conference, The President’s Conference in Washington, D.C., in March.